C1-C2 Posterior Screw-Rod Fixation.

Multiple approaches for instrumentation of the upper cervical spine have evolved to treat atlantoaxial instability which, until the 20th century, was largely considered to be inoperable and managed nonsurgically with immobilization. Surgeons set out to provide safe and effective approaches in a clearly dangerous and technically complex anatomic region. It is important to provide a historical analysis of the evolution of techniques that have shaped C1-C2 instrumentation, and how the diligent efforts of surgeons to improve the biomechanical stability and fusion rates of their constructs eventually led to the prevailing Harms technique. This technique is explored by describing its surgical steps, alternative techniques, and associated outcomes. For successful instrumentation of the atlantoaxial joint, a comprehensive understanding of spinal biomechanics, surgical techniques, and anatomic variations is imperative for surgeons to develop a tailored plan for each patient's individual pathology and anatomy.

Auxin and abscisic acid play important roles in promoting glucose metabolism of reactivated young kernels of maize (Zea mays L.).

In maize, young kernels that are less competitive and have poor sink activity often abort. Studies have indicated that such poor competitiveness depends, in part, on the regulation by auxin (IAA) and abscisic acid (ABA). However, the mechanisms for such effects remain unclear. We used pollination-blocking and hand-pollination treatments accompanied by multi-omics and physiological tests, to identify underlying mechanism by which IAA and ABA, along with sugar signaling affect kernel development. Results showed that preventing pollination of the primary ears reactivated kernels in the secondary ears and altered both sugar metabolism and hormone signaling pathways. This was accompanied by increased enzyme activities in carbon metabolism and concentrations of glucose and starch, as well as increased levels of IAA and decreased levels of ABA in the reactivated kernels. Positive and negative correlations were observed between IAA, ABA contents and cell wall invertase (CWIN) activity, and glucose contents, respectively. In vitro culture revealed that the expression of genes involved in glucose utilization was upregulated by IAA, but downregulated by ABA. IAA could promote the expression of ABA signaling genes ZmPP2C9 and ZmPP2C13 but downregulated the expression of Zmnced5, an ABA biosynthesis gene, and ZmSnRK2.10, which is involved in ABA signal transduction. However, these genes showed opposite trends when IAA transport was inhibited. To summarize, we suggest a regulatory model for how IAA inhibits ABA metabolism by promoting the smooth utilization of glucose in reactivated young kernels. Our findings highlight the importance of IAA in ABA signaling by regulating glucose production and transport in maize.

Potassium ameliorates cotton (Gossypium hirsutum L.) fiber length by regulating osmotic and K+ /Na+ homeostasis under salt stress.

Potassium (K) application can alleviate cotton salt stress, but the regulatory mechanisms affecting cotton fiber elongation and ion homeostasis are still unclear. A two-year field experiment was conducted to explore the effects of K on the osmolyte contents (soluble sugar, K+ content, and malate) and related enzyme activities during the fiber elongation of two cotton cultivars with contrasting salt sensitivity (CCRI-79; salt tolerant cultivar, and Simian 3; salt-sensitive cultivar). Three K application treatments (0, 150, and 300 kg K2 O ha-1 ) were applied at three soil salinity levels (low salinity, EC = 1.73 ± 0.05 dS m-1 ; medium salinity, EC = 6.32 ± 0.10 dS m-1 ; high salinity, EC = 10.84 ± 0.24 dS m-1 ). K application improved fiber length and alleviated salt stress by increasing the maximum velocity of fiber elongation (Vmax ). The increase rate of K on fiber length decreased with elevating salt stress, and the increase rate of K on Vmax of CCRI-79 was greater than that of Simian3. K application can increase the enzyme activities (phosphoenolpyruvate carboxylase, PEPC, E.C. 4.1.1.31; pyrophosphatase, PPase, E.C. 3.6.1.1; and plasma membrane H+ -ATPase, PM H+ -ATPase, E.C. 3.6.3.14) as well as the content of osmolytes associated with the enzymes mentioned above. K increased the osmolyte contents under salt stress, and the increase in the K+ content of the fibers was much higher than that of soluble sugar and malate. The results of this study indicated K fertilizer application rates regulate the metabolism of osmolytes in cotton fiber development under salt stress, K+ is more critical to fiber elongation.

Role of adipokines (omentin and visfatin) in coronary artery disease.

AIMS: Adipose tissue is considered as an endocrine organ that releases bioactive factors known as adipokines which contribute to the pathogenesis of rotundity-linked metabolic and cardiovascular complications. Rotundity is a major predisposer for the development and progression of coronary artery disease (CAD). DATA SYNTHESIS: The literature survey from various databases such as Pubmed/Medline, DOAJ, Scopus, Clarivate analytics/Web of Science and Google Scholar were used to prepare this article. The epidemic of rotundity has gained significant attention to understand the biology of adipocytes and the metabolism of adipose tissue in obese individuals. In CAD, visfatin/NAMPT was primarily indicated as a clinical marker of atherosclerosis, endothelial dysfunction and vascular injury having a prognostic significance. Visfatin/NAMPT is a factor that promotes vascular inflammation and atherosclerosis. Omentin is an anti-inflammatory and anti-atherogenic adipokine regulating cardiovascular functions. CONCLUSIONS: This review highlights and summarizes the scientific information pertaining to the role of the adipokines - omentin and visfatin in CAD.

Evaluation of serum adipokines (omentin-1 and visfatin) in coronary artery disease at a North Indian hospital.

Objective. Adipose tissue is considered to be an endocrine organ that secretes bioactive substances known as adipokines that contribute to the pathophysiology of metabolic and coronary diseases related to obesity. In this study, various novel biomarkers, such as inflammatory markers that are pro-inflammatory (visfatin) and anti-inflammatory (omentin-1), as prognostic indicators for people with coronary artery disease (CAD) were investigated. Methods. In this study, 30 diabetic patients with CAD, 30 diabetic patients without CAD, and 30 healthy control counterparts were included. Serum omentin and visfatin concentrations were evaluated by solid-phase enzyme linked immunosorbent assay (ELISA) kit. Patients with established diagnosis of CAD based on angiography, ECG, and elevated cardiac marker level were included into the study. Patients with cardioembolic stroke, cerebral venous sinus thrombosis, CNS vasculitis, and hemorrhage due to trauma, tumor, vascular malformation, and coagulopathy were excluded. Results. The serum omentin-1 levels were significantly higher in the healthy controls in comparison with the diabetic group (p<0.0001) and serum visfatin levels were significantly higher in the diabetic group in comparison with the healthy controls (p<0.0001). The serum omentin levels were significantly higher in the diabetic group in comparison with the cardio-diabetic group (p<0.0001) and serum visfatin levels were significantly higher in the cardio-diabetic group in comparison with the diabetic group (p<0.0001). The serum omentin-1 showed negative correlation with the serum visfatin in the cardio-diabetic group. Conclusion. The adipokines, such as omentin and visfatin, may be good therapeutic candidates in preventing or ameliorating CAD.

Comparative Efficacy of Adjuvant Nonopioid Analgesia in Adult Cardiac Surgical Patients: A Network Meta-Analysis.

OBJECTIVES: To compare the relative efficacy of adjuvant nonopioid analgesic regimens in adult cardiac surgical patients. DESIGN: This frequentist, random-effects network meta-analysis (NMA) was prospectively registered on PROSPERO (CRD42021282913) and conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses for Network Meta-Analyses (PRISMA-NMA). The risk of bias (RoB) and confidence of evidence were assessed by RoB 2 and Confidence in Network Meta-Analysis, respectively. Relevant databases were searched from inception to October 9, 2021. SETTING: A total of 124 (N = 26,257) randomized controlled trials were included, of which 110 were analyzed. PARTICIPANTS: Trials enrolling adults (≥18 years of age) undergoing cardiac surgery that compared nonopioid analgesics against other nonopioid analgesics, placebo, or no additional treatment, as adjuvants to standard analgesic management, and reported at least 1 of the outcomes of interest. MEASUREMENT AND MAIN RESULTS: Outcomes of interest included resting postoperative pain scores at 24 hours. Compared with standard care and/or placebo, pain scores were reduced significantly by 10 different regimens, including acetaminophen (N = 176; mean difference [MD] -0.66 points, 95% CI -1.16 to -0.15 points; high confidence), magnesium (N = 323; -0.05 points, 95% CI -0.07 to -0.02 points; high confidence), gabapentin (N = 96; MD -0.40 points, 95% CI -0.71 to -0.09; moderate confidence), and clonidine (N = 64; MD v0.38 points, 95% CI -0.73 to v0.04 points; moderate confidence). Indomethacin, diclofenac, magnesium, and gabapentin significantly reduced 24-hour opioid consumption. Four regimens significantly decreased the intensive care unit length of stay. Hydrocortisone, dexmedetomidine, and clonidine significantly decreased the duration of mechanical ventilation. Magnesium decreased, while methylprednisolone significantly increased, the risk of myocardial infarction. CONCLUSIONS: Given the increasing emphasis on enhanced recovery after surgery(ERAS) protocols and the eventual goal of limiting opiate prescriptions postoperatively, the authors' data suggested far greater use of nonopioid adjuncts to minimize pain and enhance recovery following cardiac surgery.

Outcomes of dexmedetomidine versus propofol sedation in critically ill adults requiring mechanical ventilation: a systematic review and meta-analysis of randomised controlled trials.

BACKGROUND: Guidelines have recommended the use of dexmedetomidine or propofol for sedation after cardiac surgery, and propofol monotherapy for other patients. Further outcome data are required for these drugs. METHODS: This systematic review and meta-analysis was prospectively registered on PROSPERO. The primary outcome was ICU length of stay. Secondary outcomes included duration of mechanical ventilation, ICU delirium, all-cause mortality, and haemodynamic effects. Intensive care patients were analysed separately as cardiac surgical, medical/noncardiac surgical, those with sepsis, and patients in neurocritical care. Subgroup analyses based on age and dosage were conducted. RESULTS: Forty-one trials (N=3948) were included. Dexmedetomidine did not significantly affect ICU length of stay across any ICU patient subtype when compared with propofol, but it reduced the duration of mechanical ventilation (mean difference -0.67 h; 95% confidence interval: -1.31 to -0.03 h; P=0.041; low certainty) and the risk of ICU delirium (risk ratio 0.49; 95% confidence interval: 0.29-0.87; P=0.019; high certainty) across cardiac surgical patients. Dexmedetomidine was also associated with a greater risk of bradycardia across a variety of ICU patients. Subgroup analyses revealed that age might affect the incidence of haemodynamic side-effects and mortality among cardiac surgical and medical/other surgical patients. CONCLUSION: Dexmedetomidine did not significantly impact ICU length of stay compared with propofol, but it significantly reduced the duration of mechanical ventilation and the risk of delirium in cardiac surgical patients. It also significantly increased the risk of bradycardia across ICU patient subsets.

Electromagnetic interference induced ventricular tachycardia in left ventricular assist device.

Left ventricular assist devices (LVAD) have been increasingly utilized end-stage heart failure despite guidelinedirected medical therapy (due to limited organ availability) as a bridge to transplant or destination therapy, with improved overall survival.Majority of patients undergoing LVAD implantation have pre-existing implantable cardioverter-defibrillator (ICD) in-situ.We present a case of device-device interaction resulting in EMI inducing recurrent inappropriate device therapies inducing ventricular arrhythmia followed by the inappropriate triggering of noise reversion mode, thereby inhibiting device therapies.With the increase in number of end-stage heart failure patients with ICDs in situ (and limited organ availability) undergoing LVAD implantation, it is imperative to recognize potential device-device interactions to avoid unwarranted invasive interventions.

Remotely Monitoring COVID-19 Patient Health Condition Using Metaheuristics Convolute Networks from IoT-Based Wearable Device Health Data.

Today, COVID-19-patient health monitoring and management are major public health challenges for technologies. This research monitored COVID-19 patients by using the Internet of Things. IoT-based collected real-time GPS helps alert the patient automatically to reduce risk factors. Wearable IoT devices are attached to the human body, interconnected with edge nodes, to investigate data for making health-condition decisions. This system uses the wearable IoT sensor, cloud, and web layers to explore the patient's health condition remotely. Every layer has specific functionality in the COVID-19 symptoms' monitoring process. The first layer collects the patient health information, which is transferred to the second layer that stores that data in the cloud. The network examines health data and alerts the patients, thus helping users take immediate actions. Finally, the web layer notifies family members to take appropriate steps. This optimized deep-learning model allows for the management and monitoring for further analysis.

Photocatalytic CO2 Reduction Using TiO2-Based Photocatalysts and TiO2 Z-Scheme Heterojunction Composites: A Review.

Photocatalytic CO2 reduction is a most promising technique to capture CO2 and reduce it to non-fossil fuel and other valuable compounds. Today, we are facing serious environmental issues due to the usage of excessive amounts of non-renewable energy resources. In this aspect, photocatalytic CO2 reduction will provide us with energy-enriched compounds and help to keep our environment clean and healthy. For this purpose, various photocatalysts have been designed to obtain selective products and improve efficiency of the system. Semiconductor materials have received great attention and have showed good performances for CO2 reduction. Titanium dioxide has been widely explored as a photocatalyst for CO2 reduction among the semiconductors due to its suitable electronic/optical properties, availability at low cost, thermal stability, low toxicity, and high photoactivity. Inspired by natural photosynthesis, the artificial Z-scheme of photocatalyst is constructed to provide an easy method to enhance efficiency of CO2 reduction. This review covers literature in this field, particularly the studies about the photocatalytic system, TiO2 Z-scheme heterojunction composites, and use of transition metals for CO2 photoreduction. Lastly, challenges and opportunities are described to open a new era in engineering and attain good performances with semiconductor materials for photocatalytic CO2 reduction.

Maize ear growth is stimulated at the fourth day after pollination by cell wall remodeling and changes in lipid and hormone signaling.

BACKGROUND: Stimulating maize ear development is an effective way of improving yield. However, limited information is available regarding the regulation of sink strength change from weak to strong at the same position of maize plants. Here, a novel method for stimulating development combined with physiological assays and proteomics was applied to explore the regulation of ear strengthened development. RESULTS: By blocking pollination of the upper ear of maize hybrid Suyu 41, the adjacent lower ear was dramatically stimulated at 4 days after pollination (DAP). Tandem mass tag (TMT)-based proteomics identified 173 differentially expressed proteins (fold change >1.2 or <0.83, P < 0.05) from 7793 total proteins. Gene ontology annotations indicated that several pathways showed noticeable changes, with a preferential distribution to cell wall remodeling, hormone signals and lipid metabolism in the stimulated kernels. Cell wall remodeling was highly mediated by chitinase, exhydrolase II and xyloglucan enotransglucosylase/hydrolase, and accompanied by increased sucrose and glucose content. A series of lipoxygenase proteins were significantly upregulated, causing a significant alteration in lipid metabolism. Hormone signals were influenced by the expression of the proteins involved in indole-3-acetic acid (IAA) transport, zeatin (ZT) biosynthesis and abscisic acid (ABA) signal response, and increased IAA, ZT and ABA content. CONCLUSION: The critical time for understanding the mechanism by which ear growth is stimulated is 4 DAP. Comparative proteomics and physiological analysis revealed that lipid metabolism enhancement, cell wall remodeling and changes in hormone signaling (IAA, ZT and ABA) were all important in stimulating early ear development. Proper regulation of these pathways may improve ear development, resulting in increased maize yield. © 2022 Society of Chemical Industry.

Evaluating Compliance With the Ottawa Rules: A Retrospective Clinical Audit at a District General Hospital in the UK.

BACKGROUND: The Ottawa Rules are clinical decision tools designed to assist healthcare providers in determining the need for radiographs in patients with ankle or knee injuries. Compliance with these rules can lead to more efficient use of resources and reduced radiation exposure. OBJECTIVE: This retrospective clinical audit aimed to evaluate healthcare provider's compliance with the Ottawa Rules in an Emergency Department setting and assess the positivity rates of requested knee and ankle X-rays. METHODS: A two-cycle retrospective audit was conducted at Lincoln County Hospital's Emergency Department, involving 648 X-rays collected in two cycles. In between, multiple interventions were implemented to improve the outcomes. RESULTS: The study revealed varying levels of compliance with the Ottawa Rules, with higher compliance observed for knee X-rays than ankle X-rays. The compliance for knee X-rays improved from 74.6% to 89.9% and ankle X-rays improved from 33.1% to 75.8%. Positivity rates for ankle radiographs were higher than knee radiographs in both cycles. The interventions implemented between the cycles significantly improved compliance rates with the Ottawa Rules. CONCLUSION: The findings underscore the importance of adherence to the Ottawa Rules in optimizing patient care and resource utilization. The study suggests the need for continued education and periodic audits to maintain and further improve compliance rates. Additionally, the higher positivity rates for ankle radiographs highlight the importance of targeted imaging strategies based on clinical guidelines.

Grasp Posture Variability Leads to Greater Ipsilateral Sensorimotor Beta Activation During Simulated Prosthesis Use.

Motor behaviour using upper-extremity prostheses of different levels is greatly variable, leading to challenges interpreting ideal rehabilitation strategies. Elucidating the underlying neural control mechanisms driving variability benefits our understanding of adaptation after limb loss. In this follow-up study, non-amputated participants completed simple and complex reach-to-grasp motor tasks using a body-powered transradial or partial-hand prosthesis simulator. We hypothesised that under complex task constraints, individuals employing variable grasp postures will show greater sensorimotor beta activation compared to individuals relying on uniform grasping, and activation will occur later in variable compared to uniform graspers. In the simple task, partial-hand variable and transradial users showed increased neural activation from the early to late phase of the reach, predominantly in the hemisphere ipsilateral to device use. In the complex task, only partial-hand variable graspers showed a significant increase in neural activation of the sensorimotor cortex from the early to the late phase of the reach. These results suggest that grasp variability may be a crucial component in the mechanism of neural adaptation to prosthesis use, and may be mediated by device level and task complexity, with implications for rehabilitation after amputation.

Current Perspectives in Pre- and Diabetic Peripheral Neuropathy Diagnosis and Management: An Expert Statement for the Gulf Region.

Peripheral neuropathy (PN) significantly impacts the quality of life, causing substantial morbidity and increased mortality, as well as escalating healthcare costs. While PN can have various causes, the most common form, diabetic peripheral neuropathy, poses considerable risks for potential complications. Diabetic peripheral neuropathy (DPN) affects over 50% of people with prediabetes and diabetes. Despite its prevalence, a global gap in diagnosis and management exists, exacerbated by the COVID-19 pandemic. This expert consensus was formulated through a comprehensive evaluation by a panel of experts, informed by a focused literature review, aiming to establish a clinically robust approach to diagnosing and managing pre- and diabetic PN with the early utilization of neurotropic B vitamins. This document offers a consensus perspective on the existing challenges in diagnosing and managing PN, focusing on DPN. The expert panel proposes measures to address this underdiagnosed burden, highlighting the importance of early intervention through innovative screening methods, integrated care approaches, and therapeutic strategies. The document advocates for increased awareness, targeted campaigns, and proactive care strategies to bridge gaps in the patient care of individuals with diabetes, emphasizing the importance of early detection and timely management to improve overall health outcomes. Specific recommendations include incorporating simplified questionnaires and innovative screening methods into routine care, prioritizing neurotropic B vitamin supplementation, optimizing glucagon-like peptide 1 (GLP-1) receptor agonist treatments, and adopting a holistic approach to neuropathy management. The consensus underscores the urgent need to address the underdiagnosis and undertreatment of PN, offering practical measures to enhance early detection and improve health outcomes for individuals with DPN.

Camptocormia in Parkinson Disease: Systematic Review of Management Using Spine Surgery.

OBJECTIVE: Postural abnormalities are a debilitating symptom of Parkinson disease (PD) that may require spinal intervention. Camptocormia is a unique abnormality most seen in PD, defined by a severe forward flexion of the trunk that completely resolves when supine. The condition presents a challenge due to an undefined pathophysiology and optimal therapeutic approach in a high-risk patient population. In this study, we systematically reviewed the literature regarding the use of spine surgery for the treatment of camptocormia in PD. METHODS: PubMed, Embase, Web of Science, and Cochrane Library were systematically queried for studies involving spine surgery as treatment of PD-associated camptocormia. Studies involving nonsurgical management, involving deep brain stimulation, involving noncamptocormic PD patients undergoing surgery, or were out of scope were excluded. RESULTS: The search resulted in 5 studies, with a total of 19 patients with PD with camptocormia who underwent spine surgery (73.7% women). The mean age was 69.5 years (range, 59-83), and the mean PD duration was 69.5 months (range, 36-84). Of 19 patients, 11 required surgical revision (57.9%), with an average of 0.68 revisions per patient (range, 0-2). Radiographic and patient-reported outcomes were inconsistently reported yet showed improvement. Ultimately, 18 patients were reported to have positive outcomes. CONCLUSIONS: Despite an increased risk of complication and revision that is inherent to patients with PD, spine surgery has been proven as a reasonable alternative that should be prospectively studied further because 18 of 19 patients had favorable outcomes.

Effectiveness of the Buzzy Bee device on pain perception during invasive pricks among school age children: An interventional study.

BACKGROUND: Children often develop phobia toward needle pricks and invasive procedures. It is difficult for medical personnel to manage children's pain when they are in the hospital. When it comes to assessing and treating children's discomfort, nurses interact with them the most. The main objective of the study was to evaluate the effectiveness of the Buzzy Bee device on pain perception among children undergoing invasive needle pricks as part of their treatment. MATERIALS AND METHODS: The study used a quantitative approach with a quasi-experimental design employing simple random sampling. A post-test-only design was used. After obtaining ethical clearance, data collection was done in the pediatric outpatient department and pediatric wards of Sultan Qaboos University Hospital, Muscat, Oman, between February 2020 and August 2021. Faces Pain Rating Scale for children was used to rate the pain during the procedure, which is a standardized tool. Data were analyzed using SPSS version 23. Descriptive and inferential statistical tests were done to analyze the data. RESULTS: Totally, 120 children along with their parents were interested in the study. After taking appropriate parental consent and children's assent, the participants were recruited by simple random sampling. They were equally divided into 60 in the experimental group and 60 in the control group. The mean age was 8.14 (+/-2.3) in both groups. Among the 120 samples, 63 (52.5%) of them were males and 57 (47.5%) were females. The majority of them had diagnoses like thalassemia, leukemia, and sickle cell and were getting cannulated for blood transfusion therapy. t-test shows that 51.7% (31 samples) reported no pain in the experimental group and 33.3% (20 samples) reported only mild pain, whereas in the control group, only 5.0% (3 samples) reported no pain and 21.7% (13 samples) reported mild pain. About 26.7% of the samples reported very much pain as against the 7% who reported very much pain in the interventional group. There was a statistically significant difference in the pain scores between the control group and the experimental group (likelihood ratio test, P = 0.0001). The Buzzy Bee method significantly reduced the pain. CONCLUSION: The introduction of a toy-like, child-friendly device, which works on the mechanism of vibrations and cold application, lessened the pain intensity during the procedure and acted as a good distractive therapy for children.

Product Distribution of Steady-State and Pulsed Electrochemical Regeneration of 1,4-NADH and Integration with Enzymatic Reaction.

The direct electrochemical reduction of nicotinamide adenine dinucleotide (NAD+) results in various products, complicating the regeneration of the crucial 1,4-NADH cofactor for enzymatic reactions. Previous research primarily focused on steady-state polarization to examine potential impacts on product selectivity. However, this study explores the influence of dynamic conditions on the selectivity of NAD+ reduction products by comparing two dynamic profiles with steady-state conditions. Our findings reveal that the main products, including 1,4-NADH, several dimers, and ADP-ribose, remained consistent across all conditions. A minor by-product, 1,6-NADH, was also identified. The product distribution varied depending on the experimental conditions (steady state vs. dynamic) and the concentration of NAD+, with higher concentrations and overpotentials promoting dimerization. The optimal yield of 1,4-NADH was achieved under steady-state conditions with low overpotential and NAD+ concentrations. While dynamic conditions enhanced the 1,4-NADH yield at shorter reaction times, they also resulted in a significant amount of unidentified products. Furthermore, this study assessed the potential of using pulsed electrochemical regeneration of 1,4-NADH with enoate reductase (XenB) for cyclohexenone reduction.

Pavement ant extract is a chemotaxis repellent for C. elegans.

Ant behavior relies on a collection of natural products, from following trail pheromones during foraging to warding off potential predators. How nervous systems sense these compounds to initiate a behavioral response remains unclear. Here, we used Caenorhabditis elegans chemotaxis assays to investigate how ant compounds are detected by heterospecific nervous systems. We found that C. elegans avoid extracts of the pavement ant ( Tetramorium immigrans ) and either osm-9 or tax-4 ion channels are required for this response. These experiments were conducted in an undergraduate laboratory course, demonstrating that new insights into interspecies interactions can be generated through genuine research experiences in a classroom setting.

Left Ventricular Outflow Obstruction From Mechanical Circulatory Support in Critical Aortic Stenosis: A Cautionary Tale.

We submit a cautionary tale of a patient with critical aortic stenosis presenting with acute myocardial infarction and cardiogenic shock, who underwent balloon aortic valvuloplasty, insertion of a transvalvular left percutaneous ventricular assist device and high-risk percutaneous coronary intervention, with a post-operative course complicated by outflow obstruction from the device itself. (Level of Difficulty: Intermediate.).